The right equipment, supplies, and management are essential to successful patient treatment and the viability of a phlebology practice. Even though an experienced practitioner of another specialty will likely already have on hand most of the supplies necessary to perform sclerotherapy of spider and reticular veins, he or she will need to learn the administrative nuances of a phlebology practice.
Sclerosing solutions and a few disposable items are all that is necessary at the most basic level. To progress to the next level of treating varicose veins, to recognize venous reflux, and to minimize side effects, the minimum diagnostic equipment necessary is a handheld Doppler device. For thorough venous mapping and therapeutic decision-making, however, an ultrasound unit is needed. Fortunately, sophisticated portable Duplex ultrasound devices capable of detailed venous mapping and use in treatment of larger refluxing vessels are available for in-office use.
Systematic diagnostic evaluation and meticulous technique will help to reduce complications and improve results. Diagnostic reevaluation during the course of treatment or on patients’ return visits may often be necessary. Almost all patients with C2 disease or worse will require Duplex examination for adequate treatment. Many of these patients will have underlying saphenous trunk insufficiency requiring treatment beyond sclerotherapy. Physicians may choose to pursue appropriate training to perform outpatient endovenous ablation of such saphenous trunks. Investment in radiofrequency or laser ablation equipment follows. Treatment of such major trunks with foam sclerotherapy is in the investigational stage in the United States.
PATIENT EDUCATION AND DOCUMENTATION
Successful patient outcomes in a phlebology practice depend on thorough patient education and informed consent. Brochures and handouts are useful to enhance patient awareness and to answer common questions asked by patients and referring physicians. Pre- and posttreatment instruction sheets will help to ensure that the patient is prepared for treatment and increase compliance with posttreatment directions. Appendix B offers samples, including sources for brochures. Sources of patient brochures include the American Society for Dermatologic Surgery, American Academy of Dermatology, American College of Phlebology as well as private firms. A patient-oriented educational video, on DVD or watched online via website streaming, helps improve patient understanding.
Review of this information with the patient before consent is obtained allows the physician to more efficiently concentrate on evaluation of the patient and development of a treatment plan. The physician should always review the patient’s understanding of the proposed treatment and risks before actually beginning the treatment. Key points for patients to understand are that sclerotherapy is a gradual treatment process involving several treatment sessions, that it takes weeks to months to see results, and that periodic maintenance treatment is likely to be necessary for most patients. When patients return for such treatment after one or more years, it is advisable to review consent again to be sure that they understand.